Provider Demographics
NPI:1992891147
Name:MITCHEM, BARBARA GATES (DC)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:GATES
Last Name:MITCHEM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:GATES
Other - Last Name:MITCHEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LO LICENSED ORTHOTIS
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-0627
Mailing Address - Country:US
Mailing Address - Phone:979-733-9500
Mailing Address - Fax:979-733-9501
Practice Address - Street 1:109 SHULT DR
Practice Address - Street 2:SUITE 208
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3009
Practice Address - Country:US
Practice Address - Phone:979-733-9500
Practice Address - Fax:979-733-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X575Medicare PIN
TX8F5004Medicare PIN